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Bilgihan MT, Ciftciler R. The Effect of Obesity and Body Mass Index on Hematologic Malignancies. Metab Syndr Relat Disord 2023; 21:353-361. [PMID: 37410513 DOI: 10.1089/met.2023.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
A thorough examination of the available literature has revealed a well-established association of obesity and high body mass index (BMI) with an increased risk of various types of cancers, including hematologic malignancies. Specifically, the studies reviewed indicate a clear correlation between obesity and an increased risk of leukemias, lymphomas, multiple myeloma, myelodysplastic syndrome, and myeloproliferative diseases. Despite the established association of obesity and high BMI with hematologic malignancies, the underlying mechanisms remain largely undetermined. The development of hematologic malignancies may be influenced by several mechanisms associated with obesity and high BMI, including chronic inflammation, hormonal imbalances, adiposopathies, and metabolic dysregulation. Furthermore, there is mounting evidence indicating that obesity and high BMI may have a negative impact on the response to treatment and overall survival in patients with hematologic malignancies. This article aims to increase awareness and summarize the current state of research on the impact of obesity on hematologic malignancies, including the mechanisms by which obesity may influence the development and progression of these diseases. In addition, the current review highlights the need for effective weight management strategies in patients with hematologic malignancies to improve outcomes and mitigate the risk of complications.
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Affiliation(s)
| | - Rafiye Ciftciler
- Department of Hematology, Selcuk University, Faculty of Medicine, Konya, Turkey
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2
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Hu M, Ding Y, Zhang H, Guo W, Li Y, Jin Z, Qu C, Xia F. Body mass index-associated responses to an ABVD-like regimen in newly-diagnosed patients with Hodgkin lymphoma. Front Pharmacol 2023; 14:1195907. [PMID: 37680722 PMCID: PMC10482088 DOI: 10.3389/fphar.2023.1195907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
Background: The role of body mass index (BMI) in the treatment outcomes of lymphoma patients is controversial. While investigating the efficacy of ABVD-like regimen in Hodgkin lymphoma (HL) patients, we observed that obese patients had poor responses. To better understand this clinical phenomenon, we evaluated the effect of BMI on responses to ABVD-like chemotherapy in HL patients. Methods: This retrospective cohort study evaluated the clinical outcomes of all 67 patients with confirmed HL who were treated at the First Affiliated Hospital of Soochow University from November 2016 to March 2023 with an ABVD-like regimen as first-line chemotherapy. Baseline patient characteristics and clinical outcomes were compared across different BMI categories. The primary end-point was the overall response rate defined as the proportion of the HL patients who achieved complete response or partial response. The additional end-points included progression-free survival and overall survival. Results: The median age of the HL patients was 31 years old. Of the patients, 10.4% were obese, and 17.9% patients were overweight. Interim and end-term response evaluations revealed overall response rates of 98.5% and 83.6%, respectively. The proportion of patients with potential poor prognostic factors (IPS risk factors) did not differ significantly in the responders versus non-responders. However, non-responders had a higher average BMI when compared with responders (p = 0.002). Poor overall response rates in higher BMI patients indeed manifested with shorter progression free survival (p = 0.013). The minimum relative dose of the ABVD-like regimen in the overweight and obese groups was significantly lower than in the normal weight group (p < 0.001). Conclusion: Our analyses show that >80% of newly-diagnosed HL patients responded to the ABVD-like regimen. We find that being obese or overweight at the time of diagnosis correlated with a poorer overall response rate and that BMI was an independent risk factor in HL patients treated with the ABVD-like regimen. Lower doses of ABVD-like regimen contributed to the discrepant findings of responses in the high BMI groups. These findings indicate that newly-diagnosed, obese HL patients receiving an ABVD-like regimen require personalized treatment.
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Affiliation(s)
- Min Hu
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiduo Ding
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haizhou Zhang
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Guo
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Li
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhengming Jin
- Department of Hematology, Collaborative Innovation Center of Hematology, Institute of Blood and Marrow Transplantation, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China
| | - Changju Qu
- Department of Hematology, Collaborative Innovation Center of Hematology, Institute of Blood and Marrow Transplantation, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China
| | - Fan Xia
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
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3
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Jaswal S, Sanders V, Pullarkat P, Teja S, Salter A, Watkins MP, Atagu N, Ludwig DR, Mhlanga J, Mellnick VM, Peterson LR, Bartlett NL, Kahl BS, Fehniger TA, Ghobadi A, Cashen AF, Mehta-Shah N, Ippolito JE. Metabolic Biomarkers Assessed with PET/CT Predict Sex-Specific Longitudinal Outcomes in Patients with Diffuse Large B-Cell Lymphoma. Cancers (Basel) 2022; 14:2932. [PMID: 35740596 PMCID: PMC9221486 DOI: 10.3390/cancers14122932] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
In many cancers, including lymphoma, males have higher incidence and mortality than females. Emerging evidence demonstrates that one mechanism underlying this phenomenon is sex differences in metabolism, both with respect to tumor nutrient consumption and systemic alterations in metabolism, i.e., obesity. We wanted to determine if visceral fat and tumor glucose uptake with fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) could predict sex-dependent outcomes in patients with diffuse large B-cell lymphoma (DLBCL). We conducted a retrospective analysis of 160 patients (84 males; 76 females) with DLBCL who had imaging at initial staging and after completion of therapy. CT-based relative visceral fat area (rVFA), PET-based SUVmax normalized to lean body mass (SULmax), and end-of-treatment FDG-PET 5PS score were calculated. Increased rVFA at initial staging was an independent predictor of poor OS only in females. At the end of therapy, increase in visceral fat was a significant predictor of poor survival only in females. Combining the change in rVFA and 5PS scores identified a subgroup of females with visceral fat gain and high 5PS with exceptionally poor outcomes. These data suggest that visceral fat and tumor FDG uptake can predict outcomes in DLBCL patients in a sex-specific fashion.
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Affiliation(s)
- Shama Jaswal
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.J.); or (V.S.); (D.R.L.); (J.M.); (V.M.M.)
| | - Vanessa Sanders
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.J.); or (V.S.); (D.R.L.); (J.M.); (V.M.M.)
| | - Priyanka Pullarkat
- Washington University School of Medicine, St. Louis, MO 63110, USA; (P.P.); (N.A.)
| | - Stephanie Teja
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Marcus P. Watkins
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Norman Atagu
- Washington University School of Medicine, St. Louis, MO 63110, USA; (P.P.); (N.A.)
| | - Daniel R. Ludwig
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.J.); or (V.S.); (D.R.L.); (J.M.); (V.M.M.)
| | - Joyce Mhlanga
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.J.); or (V.S.); (D.R.L.); (J.M.); (V.M.M.)
| | - Vincent M. Mellnick
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.J.); or (V.S.); (D.R.L.); (J.M.); (V.M.M.)
| | - Linda R. Peterson
- Department of Medicine, Division of Cardiology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Nancy L. Bartlett
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Brad S. Kahl
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Todd A. Fehniger
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Armin Ghobadi
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Amanda F. Cashen
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Neha Mehta-Shah
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Joseph E. Ippolito
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.J.); or (V.S.); (D.R.L.); (J.M.); (V.M.M.)
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO 63110, USA
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4
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Silvestris N, Argentiero A, Natalicchio A, D'Oronzo S, Beretta GD, Acquati S, Adinolfi V, Di Bartolo P, Danesi R, Faggiano A, Ferrari P, Gallo M, Gori S, Morviducci L, Russo A, Tuveri E, Zatelli MC, Montagnani M, Giorgino F. Antineoplastic dosing in overweight and obese cancer patients: an Associazione Italiana Oncologia Medica (AIOM)/Associazione Medici Diabetologi (AMD)/Società Italiana Endocrinologia (SIE)/Società Italiana Farmacologia (SIF) multidisciplinary consensus position paper. ESMO Open 2021; 6:100153. [PMID: 33984679 PMCID: PMC8134762 DOI: 10.1016/j.esmoop.2021.100153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 01/22/2023] Open
Abstract
Most anticancer molecules are administered in body-size-based dosing schedules, bringing up unsolved issues regarding pharmacokinetic data in heavy patients. The worldwide spread of obesity has not been matched by improved methods and strategies for tailored drug dosage in this population. The weight or body surface area (BSA)-based approaches may fail to fully reflect the complexity of the anthropometric features besides obesity in cancer patients suffering from sarcopenia. Likewise, there is a lack of pharmacokinetic data on obese patients for the majority of chemotherapeutic agents as well as for new target drugs and immunotherapy. Therefore, although the available findings point to the role of dose intensity in cancer treatment, and support full weight-based dosing, empirical dose capping often occurs in clinical practice in order to avoid toxicity. Thus a panel of experts of the Associazione Italiana Oncologia Medica (AIOM), Associazione Medici Diabetologi (AMD), Società Italiana Endocrinologia (SIE), and Società Italiana Farmacologia (SIF), provides here a consensus statement for appropriate cytotoxic chemotherapy and new biological cancer drug dosing in obese patients. The worldwide spread of obesity is an emerging challenge also in cancer patients Weight or BSA-based approaches do not adequately address the critical issue of optimal dosing for cancer drugs under obesity Empirical dose capping is often employed in clinical practice to avoid toxicities among overweight and obese patients There is a lack of clinical and pharmacokinetic studies in this population Clinical practice recommendations should guide suitable dosing of cytotoxic and biological cancer drugs in obese patients
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Affiliation(s)
- N Silvestris
- Medical Oncology Unit, IRCCS Istituto Tumori 'Giovanni Paolo II', Bari, Italy; Department of Biomedical Sciences and Human Oncology, Division of Medical Oncology, University of Bari Aldo Moro, Bari, Italy.
| | - A Argentiero
- Medical Oncology Unit, IRCCS Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - A Natalicchio
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - S D'Oronzo
- Department of Biomedical Sciences and Human Oncology, Division of Medical Oncology, University of Bari Aldo Moro, Bari, Italy; Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - G D Beretta
- Medical Oncology Department, Humanitas Gavazzeni, Bergamo, Italy
| | - S Acquati
- Endocrinology Unit, Ospedale Pierantoni-Morgagni, Forlì, Italy
| | - V Adinolfi
- Endocrinology and Diabetology Unit, ASL Verbano Cusio Ossola, Domodossola, Italy
| | - P Di Bartolo
- Diabetology Clinic, Rete Clinica di Diabetologia Aziendale - Dipartimento, Internistico di Ravenna - AUSL Romagna, Ravenna, Italy
| | - R Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Faggiano
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - P Ferrari
- Palliative Care Unit, Istituti Clinici Scientifici Maugeri SPA SB, IRCCS (PV), Pavia PV, Italy
| | - M Gallo
- Endocrinology and Metabolic Diseases Unit of AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - S Gori
- Oncologia Medica, IRCCS Ospedale Don Calabria-Sacro Cuore di Negrar, Verona, Italy
| | - L Morviducci
- Diabetology and Nutrition Unit, Department of Medical Specialities, ASL Roma 1 - S. Spirito Hospital, Rome, Italy
| | - A Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - E Tuveri
- Diabetology, Endocrinology and Metabolic Diseases Service, ATS Sardegna - ASSL Carbonia-Iglesias, Italy
| | - M C Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - M Montagnani
- Department of Biomedical Sciences and Human Oncology, Division of Medical Oncology, University of Bari Aldo Moro, Bari, Italy
| | - F Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
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5
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Besutti G, Massaro F, Bonelli E, Braglia L, Casali M, Versari A, Ligabue G, Pattacini P, Cavuto S, Merlo DF, Luminari S, Merli F, Vaccaro S, Pellegrini M. Prognostic Impact of Muscle Quantity and Quality and Fat Distribution in Diffuse Large B-Cell Lymphoma Patients. Front Nutr 2021; 8:620696. [PMID: 34026803 PMCID: PMC8138563 DOI: 10.3389/fnut.2021.620696] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/07/2021] [Indexed: 12/25/2022] Open
Abstract
Baseline CT scans of 116 patients (48% female, median 64 years) with diffuse large B-cell lymphoma (DLBCL) were retrospectively reviewed to investigate the prognostic role of sarcopenia and fat compartment distributions on overall survival (OS), progression-free survival (PFS), and early therapy termination. Skeletal muscle index (SMI), skeletal muscle density (SMD), and intermuscular adipose tissue (IMAT) were quantified at the level of the third lumbar vertebra (L3) and proximal thigh (PT). Low L3-SMD, but not low L3-SMI, was associated with early therapy termination (p = 0.028), shorter OS (HR = 6.29; 95% CI = 2.17-18.26; p < 0.001), and shorter PFS (HR = 2.42; 95% CI = 1.26-4.65; p = 0.008). After correction for sex, International Prognostic Index (IPI), BMI, and R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), low L3-SMD remained associated with poor OS (HR = 3.54; 95% CI = 1.10-11.40; p = 0.034) but not with PFS. Increased PT-IMAT was prognostic for poor OS and PFS after correction for sex, IPI, BMI, and R-CHOP therapy (HR = 1.35; CI = 1.03-1.7; p = 0.03, and HR = 1.30; CI = 1.04-1.64; p = 0.024, respectively). Reduced muscle quality (SMD) and increased intermuscular fat (IMAT), rather than low muscle quantity (SMI), are associated with poor prognosis in DLBCL, when measured at the L3 level, and particularly at the level of the proximal thigh. The proximal thigh represents a novel radiological landmark to study body composition.
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Affiliation(s)
- Giulia Besutti
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Fulvio Massaro
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Hematology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Efrem Bonelli
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Braglia
- Research and Biostatistics Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimiliano Casali
- Nuclear Medicine Unit, Oncology Department, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Oncology Department, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Guido Ligabue
- Radiology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Pierpaolo Pattacini
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Research and Biostatistics Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Domenico F Merlo
- Research and Biostatistics Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Merli
- Hematology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Salvatore Vaccaro
- Clinical Nutrition Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Pellegrini
- Clinical Nutrition Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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6
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Nagata A, Kanemasa Y, Sasaki Y, Nakamura S, Okuya T, Funasaka C, Kageyama A, Shimoyama T, Omuro Y. Clinical impact of controlling nutritional status score on the prognosis of patients with diffuse large B-cell lymphoma. Hematol Oncol 2020; 38:309-317. [PMID: 32223021 DOI: 10.1002/hon.2732] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/26/2020] [Accepted: 03/18/2020] [Indexed: 12/19/2022]
Abstract
The controlling nutritional status (CONUT) score is a nutritional index calculated from serum albumin and total cholesterol levels and lymphocyte counts. Its role in predicting clinical outcomes of diffuse large B-cell lymphoma (DLBCL) has not been evaluated. In this retrospective study, data from 476 patients with DLBCL were analyzed. The cutoff value of the CONUT score was set as 4. CONUT score significantly stratified the overall survival (OS) and the progression-free-survival (PFS) (5-year OS, 49.0% vs 83.2%, P < .001; 5-year PFS, 46.1% vs 73.1%, P < .001) of the patients. Among patients at high-intermediate or high risk, as per the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI), 5-year OS was lower in patients with high CONUT scores than in those with low CONUT scores (high-intermediate risk, 51.2% vs 75.5%, P < .001; high risk, 29.9% vs 63.3%, P = .007). Additionally, in patients with high CONUT scores, maintenance of relative dose intensity (RDI) of chemotherapy did not affect the 5-year OS (RDI > 80% vs RDI ≤ 80%: 59.8% vs 50.9%, P = .73). In the present study, we have demonstrated that the CONUT score is an independent prognostic factor in patients with DLBCL.
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Affiliation(s)
- Akihito Nagata
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.,Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yusuke Kanemasa
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yuki Sasaki
- Department of Clinical Research support, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Shohei Nakamura
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Toshihiro Okuya
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Chikako Funasaka
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Akihiko Kageyama
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Tatsu Shimoyama
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yasushi Omuro
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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7
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Steinmeyer Z, Gérard S, Filleron T, Lozano S, Brechemier D, Abellan Van Kan G, Mourey L, Cristol-Dalstein L, De Decker L, Rolland Y, Balardy L. Low lean mass and chemotherapy toxicity risk in the elderly: the Fraction study protocol. BMC Cancer 2019; 19:1153. [PMID: 31775667 PMCID: PMC6882112 DOI: 10.1186/s12885-019-6377-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022] Open
Abstract
Background Half of cancer cases occur in patients aged 70 and above. Majority of older patients are eligible for chemotherapy but evidence for treating this population is sparse and severe toxicities affect more than half of them. Determining prognostic biomarkers able to predict poor chemotherapy tolerance remains one of the major issues in geriatric oncology. Ageing is associated with body composition changes (increase of fat mass and loss of lean mass) independently of weight-loss. Previous studies suggest that body composition parameters (particularly muscle mass) may predict poor chemotherapy tolerance. However, studies specifically including older adults on this subject remain sparse and the majority of them study body composition based on computed tomography (CT) scanner (axial L3 section) muscle mass estimation. This method is to date not validated in elderly cancer patients. Methods This trial (Fraction) will evaluate the discriminative ability of appendicular lean mass measured by dual-energy X-ray absorptiometry (DXA) to predict severe toxicity incidence in older cancer-patients treated with first-line chemotherapy. DXA is considered the gold standard in body composition assessment in older adults. Patient’s aged ≥70 diagnosed with solid neoplasms or lymphomas at a locally advanced or metastatic stage treated for first-line chemotherapy were recruited. Patients completed a pre-chemotherapy assessment that recorded socio-demographics, tumor/treatment variables, laboratory test results, geriatric assessment variables (function, comorbidity, cognition, social support and nutritional status), oncological risk scores and body composition with DXA. Appendicular lean mass was standardized using evidence based international criteria. Participants underwent short follow-up geriatric assessments within the first 3 months, 6 months and a year after inclusion. Grade 3 to 5 chemotherapy-related toxicities, as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) were assessed at each chemotherapy cycle. Discussion The finding that body composition is associated with poor tolerance of chemotherapy could lead to consider these parameters as well as improve current decision-making algorithms when treating older adults. Trial registration ClinicalTrials.gov Identifier: NCT02806154 registered on October 2016.
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Affiliation(s)
- Zara Steinmeyer
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, University Hospital, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
| | - Stéphane Gérard
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, University Hospital, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius Regaud, IU, CT-O, Toulouse, France
| | - Stéphanie Lozano
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, University Hospital, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
| | - Delphine Brechemier
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, University Hospital, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
| | - Gabor Abellan Van Kan
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, University Hospital, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
| | - Loic Mourey
- Medical oncology department, Claudius Régaud Institute-Oncopole-Toulouse Cancer University Institute (IUCT-O), 1 avenue Irène Joliot-Curie, 31100, Toulouse, France
| | | | - Laure De Decker
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France.,EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), Université de Nantes, F-44200, Nantes, France
| | - Yves Rolland
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France.,UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France.,UMR, INSERM, 1027 University of Toulouse III, Toulouse, France
| | - Laurent Balardy
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, University Hospital, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France.
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8
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Fürstenau M, Hopfinger G, Robrecht S, Fink AM, Al-Sawaf O, Langerbeins P, Cramer P, Tresckow JV, Maurer C, Kutsch N, Hoechstetter M, Dreyling M, Lange E, Kneba M, Stilgenbauer S, Döhner H, Hensel M, Kiehl MG, Jaeger U, Wendtner CM, Goede V, Fischer K, von Bergwelt-Baildon M, Eichhorst B, Hallek M, Theurich S. Influence of obesity and gender on treatment outcomes in patients with chronic lymphocytic leukemia (CLL) undergoing rituximab-based chemoimmunotherapy. Leukemia 2019; 34:1177-1181. [PMID: 31728057 DOI: 10.1038/s41375-019-0630-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/14/2019] [Accepted: 11/03/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Moritz Fürstenau
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany.
| | - Georg Hopfinger
- Department of Internal Medicine I, Bone Marrow Transplantation, Medical University of Vienna, Vienna, Austria
| | - Sandra Robrecht
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Julia Von Tresckow
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Christian Maurer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Nadine Kutsch
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Manuela Hoechstetter
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, München Klinik Schwabing, Munich, Germany
| | - Martin Dreyling
- Department of Medicine III, University Hospital, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | | | - Michael Kneba
- Department II of Internal Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany.,Department of Hematology, Oncology and Rheumatology and José Carreras Center for Immuno and Gene Therapy, Saarland University Medical School, Homburg/Saar, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | | | - Michael G Kiehl
- Department of Internal Medicine, Frankfurt (Oder) General Hospital, Frankfurt/Oder, Germany
| | - Ulrich Jaeger
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology and Comprehensive Cancer Center (CCC), Medical University of Vienna, Vienna, Austria
| | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, München Klinik Schwabing, Munich, Germany
| | - Valentin Goede
- Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | | | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Sebastian Theurich
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany. .,Department of Medicine III, University Hospital, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany. .,Gene Center, Cancer- and Immunometabolism Research Group, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany.
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9
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Mizuno K, Nakazato T, Ito C, Fujita Y, Ogura S, Kamiya T, Sakurai A, Aisa Y, Mori T. The prognostic value of geriatric nutritional risk index in patients with follicular lymphoma. Ann Hematol 2019; 98:1777-1779. [PMID: 31041513 DOI: 10.1007/s00277-019-03703-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/21/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Kota Mizuno
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Tomonori Nakazato
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan.
| | - Chisako Ito
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Yuriko Fujita
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Shinji Ogura
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Takahiro Kamiya
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Aki Sakurai
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Yoshinobu Aisa
- Department of Hematology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan
| | - Takehiko Mori
- Division of Hematology, Keio University School of Medicine, Tokyo, Japan
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10
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Stevenson JKR, Qiao Y, Chan KKW, Beca J, Isaranuwatchai W, Guo H, Schwartz D, Arias J, Gavura S, Dai WF, Kouroukis CT, Cheung MC. Improved survival in overweight and obese patients with aggressive B-cell lymphoma treated with rituximab-containing chemotherapy for curative intent. Leuk Lymphoma 2018; 60:1399-1408. [PMID: 30516081 DOI: 10.1080/10428194.2018.1538509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The association between obesity and survival in non-Hodgkin lymphoma is unclear. Using the Ontario Cancer Registry we conducted a retrospective analysis of incident cases of aggressive-histology B-cell lymphoma treated with a rituximab-containing regimen with curative intent between 2008-2016. 6246 patients were included. On multivariable analysis the rate of all-cause mortality was lower for the overweight body mass index (BMI 25-29.9 kg/m2) (HR 0.85; 95%CI 0.77-0.95) and obese BMI (≥30 kg/m2) (HR 0.75; 95%CI 0.67-0.85) groups compared to the normal weight group (18.5-24.9 kg/m2). Binomial logistic regression analysis revealed a lower odds ratio (OR) of admission to hospital during treatment in the overweight (OR 0.84; 95%CI 0.75-0.95) compared to normal weight BMI group. In the largest cohort to date of aggressive-histology B-cell lymphoma patients treated with rituximab, increased BMI is associated with a survival advantage, and the magnitude of this effect increases from overweight to obese BMI.
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Affiliation(s)
| | - Yao Qiao
- b Cancer Care Ontario , Ontario , Canada
| | - Kelvin K W Chan
- a Department of Medicine , University of Toronto , Toronto , Canada.,b Cancer Care Ontario , Ontario , Canada.,c Sunnybrook Health Sciences Centre , Odette Cancer Centre , Toronto , Canada.,d The Canadian Centre for Applied Research in Cancer Control , Vancouver , Canada
| | - Jaclyn Beca
- b Cancer Care Ontario , Ontario , Canada.,d The Canadian Centre for Applied Research in Cancer Control , Vancouver , Canada
| | - Wanrudee Isaranuwatchai
- a Department of Medicine , University of Toronto , Toronto , Canada.,d The Canadian Centre for Applied Research in Cancer Control , Vancouver , Canada.,e St. Michael's Hospital , Toronto , Canada
| | - Helen Guo
- b Cancer Care Ontario , Ontario , Canada
| | | | | | | | | | - C Tom Kouroukis
- b Cancer Care Ontario , Ontario , Canada.,f Juravinski Cancer Centre , McMaster University , Ontario , Canada
| | - Matthew C Cheung
- a Department of Medicine , University of Toronto , Toronto , Canada.,c Sunnybrook Health Sciences Centre , Odette Cancer Centre , Toronto , Canada
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11
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Li YJ, Yi PY, Li JW, Liu XL, Liu XY, Zhou F, OuYang Z, Sun ZY, Huang LJ, He JQ, Yao Y, Fan Z, Tang T, Jiang WQ. Increased body mass index is associated with improved overall survival in extranodal natural killer/T-cell lymphoma, nasal type. Oncotarget 2018; 8:4245-4256. [PMID: 28002803 PMCID: PMC5354828 DOI: 10.18632/oncotarget.13988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 11/30/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The role of body mass index (BMI) in lymphoma survival outcomes is controversial. The prognostic significance of BMI in extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is unclear. We evaluated the prognostic role of BMI in patients with ENKTL. METHODS We retrospectively analyzed 742 patients with newly diagnosed ENKTL. The prognostic value of BMI was compared between patients with low BMIs (< 20.0 kg/m2) and patients with high BMIs (≥ 20.0 kg/m2). The prognostic value of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) was also evaluated and compared with that of the BMI classification. RESULTS Patients with low BMIs tended to exhibit higher Eastern Cooperative Oncology Group performance status (ECOG PS) scores (≥ 2) (P = 0.001), more frequent B symptoms (P < 0.001), lower albumin levels (P < 0.001), higher KPI scores (P = 0.03), and lower rates of complete remission (P < 0.001) than patients with high BMIs, as well as inferior progression-free survival (PFS, P = 0.003), and inferior overall survival (OS, P = 0.001). Multivariate analysis demonstrated that age > 60 years, mass > 5 cm, stage III/IV, elevated LDH levels, albumin levels < 35 g/L and low BMIs were independent adverse predictors of OS. The BMI classification was found to be superior to the IPI with respect to predicting patient outcomes among low-risk patients and the KPI with respect to distinguishing between intermediate-low- and high-intermediate-risk patients. CONCLUSIONS Higher BMI at the time of diagnosis is associated with improved overall survival in ENKTL. Using the BMI classification may improve the IPI and KPI prognostic models.
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Affiliation(s)
- Ya-Jun Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China.,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Ping-Yong Yi
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China.,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Ji-Wei Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China.,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Xian-Ling Liu
- Cancer Center of the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xi-Yu Liu
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China.,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Fang Zhou
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China.,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Zhou OuYang
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China.,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Zhong-Yi Sun
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China.,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Li-Jun Huang
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China.,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Jun-Qiao He
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China.,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yuan Yao
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China.,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Zhou Fan
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China.,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Tian Tang
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China.,Radioactive Interventional Department, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Wen-Qi Jiang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
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12
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Kanemasa Y, Shimoyama T, Sasaki Y, Hishima T, Omuro Y. Geriatric nutritional risk index as a prognostic factor in patients with diffuse large B cell lymphoma. Ann Hematol 2018; 97:999-1007. [PMID: 29427185 DOI: 10.1007/s00277-018-3273-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/31/2018] [Indexed: 01/14/2023]
Abstract
The geriatric nutritional risk index (GNRI) is a simple and well-established nutritional assessment tool that is a significant prognostic factor for various cancers. However, the role of the GNRI in predicting clinical outcomes of diffuse large B cell lymphoma (DLBCL) patients has not been investigated. To address this issue, we retrospectively analyzed a total of 476 patients with newly diagnosed de novo DLBCL. We defined the best cutoff value of the GNRI as 96.8 using a receiver operating characteristic curve. Patients with a GNRI < 96.8 had significantly lower overall survival (OS) and progression-free survival (PFS) than those with a GNRI ≥ 96.8 (5-year OS, 61.2 vs. 84.4%, P < 0.001; 5-year PFS, 53.7 vs. 75.8%, P < 0.001). Multivariate analysis showed that performance status, Ann Arbor stage, serum lactate dehydrogenase, and GNRI were independent prognostic factors for OS. Among patients with high-intermediate and high-risk by National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI), the 5-year OS was significantly lower in patients with a GNRI < 96.8 than in those with a GNRI ≥ 96.8 (high-intermediate risk, 59.5 vs. 75.2%, P = 0.006; high risk, 37.4 vs. 64.9%, P = 0.033). In the present study, we demonstrated that the GNRI was an independent prognostic factor in DLBCL patients. The GNRI could identify a population of poor-risk patients among those with high-intermediate and high-risk by NCCN-IPI.
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Affiliation(s)
- Yusuke Kanemasa
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan.
| | - Tatsu Shimoyama
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
| | - Yuki Sasaki
- Department of Clinical Research Support, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yasushi Omuro
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
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13
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Morrison VA, McCall L, Muss HB, Jatoi A, Cohen HJ, Cirrincione CT, Ligibel JA, Lafky JM, Hurria A. The impact of actual body weight-based chemotherapy dosing and body size on adverse events and outcome in older patients with breast cancer: Results from Cancer and Leukemia Group B (CALGB) trial 49907 (Alliance A151436). J Geriatr Oncol 2017; 9:228-234. [PMID: 29233548 DOI: 10.1016/j.jgo.2017.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/05/2017] [Accepted: 11/13/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Actual weight-based (AWB) chemotherapy dosing is recommended for obese patients in the 2012 ASCO Clinical Practice Guideline. CALGB 49907, which utilized ABW-based adjuvant chemotherapy dosing, was a phase 3 trial in women age≥65years with early stage breast cancer, providing the opportunity to examine impact of such dosing on toxicities and outcome in older patients with breast cancer. MATERIALS AND METHODS Adverse event data were available for 615 of 633 enrolled patients. Objectives were to assess grade≥3 hematologic/non-hematologic toxicities by treatment arm, age, study entry BSA/BMI, and relapse-free (RFS) and overall survival (OS) by BSA/BMI. RESULTS The 615 patients were sub-grouped by BSA (quartiles) and standard BMI categories, with BMI underweight/normal weight categories combined. Overall, grade≥3 non-hematologic and hematologic toxicities occurred in 39.8% and 28.3% of patients, respectively. There were no significant differences in grade≥3 toxicities among BSA quartiles. However, more grade≥3 hematologic toxicities occurred in the underweight/normal weight BMI subgroup compared to overweight/obese subgroups (p=0.048). Type of chemotherapy and age had no impact on toxicity occurrence by BSA/BMI categories. RFS was superior in the 25th-50th BSA percentile patients in univariate analysis (p=0.042), as was OS in both univariate and multivariate analyses (p=0.007, p=0.009, respectively). No differences in RFS or OS were found by BMI categories. CONCLUSION Obesity was not correlated with adverse relapse or survival outcome, and grade≥3 toxicities were not greater with ABW-based dosing. This supports safety and efficacy of ABW-based dosing as per the 2012 ASCO clinical practice guideline. ClinicalTrials.gov Identifier: NCT00024102 (49907).
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Affiliation(s)
- Vicki A Morrison
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Hennepin County Medical Center, Minneapolis, MN, United States; Division of Infectious Disease, University of Minnesota, Hennepin County Medical Center, Minneapolis, MN, United States.
| | - Linda McCall
- Alliance Statistics and Data Center, Duke University, Durham, NC, United States.
| | - Hyman B Muss
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States.
| | | | - Harvey J Cohen
- Duke University Medical Center, Durham, NC, United States.
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14
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Xu X, Zhang Q, Hu G, Zhuang Q, Xing C, Shi Y, Liang B, Shen Z, Jiang S, Yu K, Feng J. Effect of initial body mass index on survival outcome of patients with myelodysplastic syndrome: a single-center retrospective study. Leuk Lymphoma 2017; 59:129-137. [PMID: 28573898 DOI: 10.1080/10428194.2017.1330477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Xi Xu
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Qianying Zhang
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Gang Hu
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Qiang Zhuang
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Chongyun Xing
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Yifen Shi
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Bin Liang
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Zhijian Shen
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Songfu Jiang
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Kang Yu
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Jianhua Feng
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
- Division of Pediatric Hematology-Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
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15
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Impact of doxorubicin dose capping on the outcome of DLBCL patients with elevated body surface area. Blood 2017; 129:2811-2813. [DOI: 10.1182/blood-2017-02-766147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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16
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Weiss L, Melchardt T, Egle A, Hopfinger G, Hackl H, Greil R, Barth J, Rummel M. Influence of body mass index on survival in indolent and mantle cell lymphomas: analysis of the StiL NHL1 trial. Ann Hematol 2017; 96:1155-1162. [PMID: 28456850 PMCID: PMC5486799 DOI: 10.1007/s00277-017-3003-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/10/2017] [Indexed: 11/25/2022]
Abstract
Obesity is a well-known risk factor for the development of cancer, but its influence on the course of disease is still controversial. We investigated the influence of body mass index (BMI) on overall survival (OS) in 502 patients with indolent non-Hodgkin’s lymphoma or mantle cell lymphoma in a subgroup analysis of the StiL (Study Group Indolent Lymphomas) NHL1 trial. We defined a cut-off of 22.55 kg/m2 by ROC calculation and Youden Index analysis and stratified patients into “low BMI” and “high BMI”. Five-year OS was significantly longer in the high BMI group (82.2%) when compared to that of the low BMI group (66.2%) (HR 0.597; 95%CI 0.370–0.963; p = 0.034). BMI was also an independent prognostic factor for OS in multivariate analysis (HR 0.541; 95%CI 0.332–0.883; p = 0.014). Of note, patients had a significantly lower BMI in the presence than patients in the absence of B-symptoms (p = 0.025). BMI significantly impacts on OS in indolent non-Hodgkin’s lymphoma and mantle cell lymphoma, which may be influenced by the effect of B-symptoms on BMI.
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Affiliation(s)
- Lukas Weiss
- Salzburg Cancer Research Institute, Department of Internal Medicine III, Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Thomas Melchardt
- Salzburg Cancer Research Institute, Department of Internal Medicine III, Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Alexander Egle
- Salzburg Cancer Research Institute, Department of Internal Medicine III, Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Georg Hopfinger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Hubert Hackl
- Division of Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Richard Greil
- Salzburg Cancer Research Institute, Department of Internal Medicine III, Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Juergen Barth
- Medizinische Klinik IV, Hospital of the Justus-Liebig-University, Giessen, Germany
| | - Mathias Rummel
- Medizinische Klinik IV, Hospital of the Justus-Liebig-University, Giessen, Germany
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17
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Kanemasa Y, Shimoyama T, Sasaki Y, Tamura M, Sawada T, Omuro Y, Hishima T, Maeda Y. Analysis of the prognostic value of BMI and the difference in its impact according to age and sex in DLBCL patients. Hematol Oncol 2017; 36:76-83. [PMID: 28449294 DOI: 10.1002/hon.2426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/27/2017] [Accepted: 04/06/2017] [Indexed: 11/05/2022]
Abstract
Studies that have evaluated the prognostic value of body mass index (BMI) in patients with diffuse large B-cell lymphoma have recently been reported. However, the impact of BMI on survival outcomes remains controversial. We retrospectively analyzed the data of 406 diffuse large B-cell lymphoma patients treated with R-CHOP or R-CHOP-like regimens. The number (%) of patients that were categorized into 1 of 4 groups according to BMI were underweight (<18.5 kg/m2 ), 58 (14.3%); normal weight (≥18.5 to <25 kg/m2 ), 262 (64.5%); overweight (≥25 to <30 kg/m2 ), 75 (18.5%); and obese (≥30.0 kg/m2 ), 11 (2.7%). While the prognosis of overweight patients was good, being similar to that of normal weight, underweight, and obese patients had a worse prognosis (5-y overall survival [OS] was 57.9%, 74.3%, 73.4%, and 40.9% for underweight, normal weight, overweight, and obese patients, respectively; P = .004). In multivariate analysis, underweight and obesity were independent prognostic factors for OS compared with normal weight (hazard ratios 2.90 and 5.17, respectively). In elderly female patients (≥70 y), patients with a low BMI (<25 kg/m2 ) had significantly inferior OS than those with a high BMI (≥25 kg/m2 ) (5-y OS, 61.5% vs 85.7%; P = .039). In contrast, in young female patients (<70 years), patients with a low BMI had significantly better OS than those with a high BMI (5-y OS, 88.6% vs 46.4%; P < .001). In male patients, there were no differences in the effect of BMI on OS between young and elderly patients. In this study, we demonstrated that being underweight and obese were independent prognostic factors compared with being normal weight. In female patients, BMI had a different impact on the prognosis of young and elderly patients, whereas in male patients, there was no difference in the effect of BMI on prognosis according to age.
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Affiliation(s)
- Yusuke Kanemasa
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tatsu Shimoyama
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yuki Sasaki
- Department of Clinical Research Support, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Miho Tamura
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Takeshi Sawada
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yasushi Omuro
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yoshiharu Maeda
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Bendtsen MD, Munksgaard PS, Severinsen MT, Bekric E, Brieghel C, Nielsen KB, Brown PDN, Dybkaer K, Johnsen HE, Bøgsted M, El-Galaly TC. Anthropometrics and prognosis in diffuse large B-cell lymphoma: a multicentre study of 653 patients. Eur J Haematol 2017; 98:355-362. [DOI: 10.1111/ejh.12835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Mette Dahl Bendtsen
- Department of Haematology; Clinical Cancer Research Center; Aalborg University Hospital; Aalborg Denmark
- Unit of Epidemiology and Biostatistics; Aalborg University Hospital; Aalborg Denmark
| | - Peter Svenssen Munksgaard
- Department of Haematology; Clinical Cancer Research Center; Aalborg University Hospital; Aalborg Denmark
| | - Marianne Tang Severinsen
- Department of Haematology; Clinical Cancer Research Center; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
| | - Eric Bekric
- Department of Haematology; Odense University Hospital; Odense Denmark
| | - Christian Brieghel
- Department of Haematology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | | | - Peter de Nully Brown
- Department of Haematology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Karen Dybkaer
- Department of Haematology; Clinical Cancer Research Center; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
| | - Hans Erik Johnsen
- Department of Haematology; Clinical Cancer Research Center; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
| | - Martin Bøgsted
- Department of Haematology; Clinical Cancer Research Center; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
| | - Tarec Christoffer El-Galaly
- Department of Haematology; Clinical Cancer Research Center; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
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Li T, Liu ZG, Liang PQ, Wang HT. Can body mass index predict the outcome of diffuse large B-cell lymphoma? A single-center retrospective study in China. Leuk Lymphoma 2016; 58:1624-1629. [PMID: 27868453 DOI: 10.1080/10428194.2016.1257793] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Tong Li
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhuo-Gang Liu
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Pei-Qi Liang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hong-Tao Wang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
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20
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Gérard S, Bréchemier D, Lefort A, Lozano S, Abellan Van Kan G, Filleron T, Mourey L, Bernard-Marty C, Rougé-Bugat ME, Soler V, Vellas B, Cesari M, Rolland Y, Balardy L. Body Composition and Anti-Neoplastic Treatment in Adult and Older Subjects - A Systematic Review. J Nutr Health Aging 2016; 20:878-888. [PMID: 27709238 DOI: 10.1007/s12603-015-0653-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The estimation of the risk of poor tolerance and overdose of antineoplastic agents protocols represents a major challenge in oncology, particularly in older patients. We hypothesize that age-related modifications of body composition (i.e. increased fat mass and decreased lean mass) may significantly affect tolerance to chemotherapy. METHOD We conducted a systematic review for the last 25 years (between 1990 and 2015), using US National library of Medicine Medline electronic bibliographic database and Embase database of cohorts or clinical trials exploring (i) the interactions of body composition (assessed by Dual X-ray Absorptiometry, Bioelectrical Impedance Analyses, or Computerized Tomography) with pharmacokinetics parameters, (ii) the tolerance to chemotherapy, and (iii) the consequences of chemotherapies or targeted therapies on body composition. RESULTS Our search identified 1504 articles. After a selection (using pre-established criteria) on titles and abstract, 24 original articles were selected with 3 domains of interest: impact of body composition on pharmacokinetics (7 articles), relationship between body composition and chemotoxicity (14 articles), and effect of anti-cancer chemotherapy on body composition (11 articles). The selected studies suggested that pharmacokinetic was influenced by lean mass, that lower lean mass could be correlated with toxicity, and that sarcopenic patients experienced more toxicities that non-sarcopenic patients. Regarding fat mass, results were less conclusive. No studies specifically explored the topic of body composition in older cancer patients. CONCLUSIONS Plausible pathophysiological pathways linking body composition, toxicity, and pharmacokinetics are sustained by the actual review. However, despite the growing number of older cancer patients, our review highlighted the lack of specific studies in the field of anti-neoplastic agents toxicity regarding body composition conducted in elderly.
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Affiliation(s)
- S Gérard
- Stéphane Gérard, CHU Purpan, Gérontopôle, Pavillon Junod, 170 avenue de Casselardit 31059 Toulouse Cedex 09, France, Tel: +33 6 78 94 44 22, Fax: +33 5 61 77 64 14, E-mail address:
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Visceral adipose tissue is prognostic for survival of diffuse large B cell lymphoma treated with frontline R-CHOP. Ann Hematol 2015; 95:409-16. [PMID: 26658607 DOI: 10.1007/s00277-015-2571-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/01/2015] [Indexed: 01/21/2023]
Abstract
The potential role of visceral adipose tissue (VAT) as a prognostic factor in patients with diffuse large B cell lymphoma (DLBCL) treated with frontline rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) immunochemotherapy was explored. Total adipose tissue and VAT were measured by analyzing positron emission tomography (PET)/computed tomography (CT) images obtained during the initial staging of patients with DLBCL. The VAT ratio was calculated as follows: VAT ratio = VAT area/total adipose tissue area. Body mass index (BMI), sex, and International Prognostic Index (IPI) were also incorporated as co-variates in the final model of multivariate Cox regression analysis for survival. A total of 156 patients with DLBCL, who were treated with frontline R-CHOP, were enrolled in our study. The median patient age was 61 years, and 81 patients were male (51.9 %). The median cycle of R-CHOP was six. The IPI risk group was a strong prognostic factor for progression-free survival (PFS) and overall survival (OS) (p < 0.001). Obese BMIs were an independent prognostic factor for PFS, but not for OS in multivariate analyses, compared to patients with normal BMIs (HR = 0.43, 95 % CI = 0.19-0.98, and p = 0.046 for PFS). A high VAT ratio (third tertile) was an independent adverse prognostic factor for PFS and OS in multivariate analyses (HR = 2.87 and 2.66, 95 % CI = 1.30-6.32 and 1.30-5.44, and p = 0.009 and 0.007 for PFS and OS, respectively). VAT ratio was an independent prognostic factor for patients with DLBCL treated with first-line R-CHOP; thus, additional large prospective studies are warranted.
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22
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Mapp S, Sandhu G, Carrington C, Hennig S. A systematic review of treatment outcomes with weight-based dosing of chemotherapy in obese adult patients with acute leukemia or lymphoma. Leuk Lymphoma 2015; 57:981-4. [DOI: 10.3109/10428194.2015.1087520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Body mass index as a prognostic factor in Asian patients treated with chemoimmunotherapy for diffuse large B cell lymphoma, not otherwise specified. Ann Hematol 2015; 94:1655-65. [DOI: 10.1007/s00277-015-2438-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/22/2015] [Indexed: 11/27/2022]
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24
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Sarkozy C, Camus V, Tilly H, Salles G, Jardin F. Body mass index and other anthropometric parameters in patients with diffuse large B-cell lymphoma: physiopathological significance and predictive value in the immunochemotherapy era. Leuk Lymphoma 2015; 56:1959-68. [PMID: 25363401 DOI: 10.3109/10428194.2014.979412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common form of aggressive non-Hodgkin lymphoma, accounting for 30-40% of newly diagnosed cases. Obesity is a well-defined risk factor for DLBCL. However, the impact of body mass index (BMI) on DLBCL prognosis is controversial. Recent studies suggest that skeletal muscle wasting (sarcopenia) or loss of fat mass can be detected by computed tomography (CT) images and is useful for predicting the clinical outcome in several types of cancer including DLBCL. Several hypotheses have been proposed to explain the differences in DLBCL outcome according to BMI or weight that include tolerance to treatment, inflammatory background and chemotherapy or rituximab metabolism. In this review, we summarize the available literature, addressing the impact and physiopathological relevance of simple anthropometric tools including BMI and tissue distribution measurements. We also discuss their relationship with other nutritional parameters and their potential role in the management of patients with DLBCL.
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Affiliation(s)
- Clémentine Sarkozy
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Université Claude Bernard , Pierre Bénite , France
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25
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Leo QJN, Ollberding NJ, Wilkens LR, Kolonel LN, Henderson BE, Le Marchand L, Maskarinec G. Obesity and non-Hodgkin lymphoma survival in an ethnically diverse population: the Multiethnic Cohort study. Cancer Causes Control 2014; 25:1449-59. [PMID: 25070667 PMCID: PMC4230453 DOI: 10.1007/s10552-014-0447-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 07/21/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Obesity increases mortality for several malignancies, but for non-Hodgkin lymphoma (NHL), the association between body mass index (BMI) and survival is unclear. We examined the association of pre-diagnostic BMI with overall and NHL-specific survival in the multiethnic cohort (MEC) study of African Americans, Native Hawaiians, Japanese Americans, Latinos, and Caucasians. METHODS MEC participants free of NHL at cohort entry and diagnosed with NHL during follow-up were included in the analyses (n = 1,331). BMI was based on self-reported weight and height at cohort entry and after 6.1 years of cohort entry. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95 % confidence intervals (CI) with BMI as time-varying exposure in relation to all-cause and NHL-specific mortality while adjusting for known confounders. RESULTS The mean age at NHL diagnosis was 70.5 (range 45-89) years. After a mean follow-up of 4.3 ± 3.5 years, 667 deaths including 450 NHL-specific deaths occurred. In multivariable models, obese patients (BMI ≥30.0 kg/m(2)) had higher all-cause (HR 1.46, 95 % CI 1.13-1.87) and NHL-specific (HR 1.77, 95 % CI 1.30-2.41) mortality compared with patients with high-normal BMI (22.5-24.9 kg/m(2)). For overweight patients (BMI = 25.0-29.9 kg/m(2)), the respective HRs were 1.21 (95 % CI 0.99-1.49) and 1.36 (95 % CI 1.06-1.75). Cases with low-normal BMI (<22.5 kg/m(2)) experienced a significant 45 % higher all-cause and a 40 % higher NHL-specific mortality. After stratification by NHL type, the adverse effect of BMI was stronger for chronic lymphocytic leukemia/small lymphocytic lymphoma than for diffuse large B cell lymphoma and follicular lymphoma. CONCLUSIONS Pre-diagnostic BMI may be a suitable prognostic marker for NHL patients.
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Affiliation(s)
- Qi Jie Nicholas Leo
- Cancer Epidemiology Program, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA,
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26
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To Cap or Not to Cap: Chemotherapy Dosing in Obese Adult Hematology Patients. Clin Pharmacol Ther 2014; 95:356-8. [DOI: 10.1038/clpt.2014.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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27
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Hong F, Habermann TM, Gordon LI, Hochster H, Gascoyne RD, Morrison VA, Fisher RI, Bartlett NL, Stiff PJ, Cheson BD, Crump M, Horning SJ, Kahl BS. The role of body mass index in survival outcome for lymphoma patients: US intergroup experience. Ann Oncol 2014; 25:669-674. [PMID: 24567515 PMCID: PMC4433526 DOI: 10.1093/annonc/mdt594] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/17/2013] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The role of body mass index (BMI) in survival outcomes is controversial among lymphoma patients. We evaluated the association between BMI at study entry and failure-free survival (FFS) and overall survival (OS) in three phase III clinical trials, among patients with diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and Hodgkin's lymphoma (HL). PATIENTS AND METHODS A total of 537, 730 and 282 patients with DLBCL, HL and FL were included in the analysis. Baseline patient and clinical characteristics, treatment received and clinical outcomes were compared across BMI categories. RESULTS Among patients with DLBCL, HL and FL, the median age was 70, 33 and 56; 29%, 29% and 37% were obese and 38%, 27% and 37% were overweight, respectively. Age was significantly different among BMI groups in all three studies. Higher BMI groups tended to have more favorable prognosis factors at study entry among DLBCL and HL patients. BMI was not associated with clinical outcome with P-values of 0.89, 0.30 and 0.40 for FFS, and 0.64, 0.67 and 0.09 for OS, for patients with DLBCL, HL and FL, respectively. The association remains non-significant after adjusting for other clinical factors in the Cox model. A subset analysis of males with DLBCL treated on R-CHOP revealed no differences in FFS (P = 0.48) or OS (P = 0.58). CONCLUSION BMI was not significantly associated with clinical outcomes among patients with DLBCL, HD or FL, in three prospective phase III clinical trials. The findings contradict some previous reports of similar investigations. Further work is required to understand the observed discrepancies.
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Affiliation(s)
- F Hong
- Dana Farber Cancer Institute, Boston, MA.
| | | | | | | | - R D Gascoyne
- British Columbia Cancer Agency, Vancouver, Canada
| | - V A Morrison
- University of Minnesota, VA Medical Center, Minneapolis, MN
| | - R I Fisher
- Fox Chase Cancer Center, Philadelphia, PA
| | | | | | - B D Cheson
- Georgetown University Hospital, Washington, DC, USA
| | - M Crump
- Princess Margaret Hospital, Toronto, Ontario, Canada
| | | | - B S Kahl
- University of Wisconsin, Madison, WI, USA
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Impact of BMI and Gender on Outcomes in DLBCL Patients Treated with R-CHOP: A Pooled Study from the LYSA. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/205215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In diffuse large B-cell lymphoma (DLBCL), the age-adjusted International Prognostic Index (aaIPI) score is currently used to predict patient outcomes and to choose the best therapeutic treatment. Body mass index (BMI) and gender are occasionally sited as prognostic factors; however, their value has never been studied in a large series of patients included in prospective clinical trials in the rituximab era. To assess the impact of BMI and gender on OS and PFS independently of the aaIPI score, we pooled 985 patients that were prospectively included in GELA studies and uniformly treated with R-CHOP. Univariate analysis indicated that high aaIPI and male gender were associated with a worse PFS, whereas high (>25) or low (<18.5) BMI scores were not. High aaIPI score was the only factor predictive for OS. In a multivariate analysis, including aaIPI score, gender, BMI, and interaction between BMI and gender, aaIPI remained the strongest predictive factor, and BMI < 18.5 was significantly associated with a worse OS but not PFS. In conclusion, in the rituximab era, the aaIPI score remains the major predictor of outcome in DLBCL patients; however, male gender and low BMI seem to impact outcome.
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Weiss L, Melchardt T, Habringer S, Boekstegers A, Hufnagl C, Neureiter D, Hopfinger G, Greil R, Egle A. Increased body mass index is associated with improved overall survival in diffuse large B-cell lymphoma. Ann Oncol 2013; 25:171-6. [PMID: 24299961 DOI: 10.1093/annonc/mdt481] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obesity is a well-known risk factor for the development of several types of cancer including lymphomas, but its influence on the course of disease is fairly unknown. Recently, a retrospective cancer registry analysis demonstrated significantly prolonged survival for overweight and obese patients with diffuse large B-cell lymphoma (DLBCL). The study population almost exclusively consisted of male US American patients of lower socioeconomic status and one-fifth of patients received cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) chemotherapy without rituximab. Therefore, it remains unclear if these results can be extrapolated to the general DLBCL population. PATIENTS AND METHODS This retrospective single-center analysis included 183 unselected DLBCL patients who were treated with rituximab and standard-dosed anthracycline-based chemoimmunotherapy as first-line therapy between January 2004 and December 2012. Patients were stratified by body mass index (BMI) into 'low BMI' (<25.0 kg/m(2)) and 'high BMI' (≥25.0 kg/m(2)). RESULTS The two groups were well balanced regarding age, performance score, international prognostic index, B-symptoms and extranodal involvement. However, there was a trend for male sex (P = 0.053) and higher-stage disease (P = 0.066) in the high-BMI group. Patients with higher BMI had significantly longer overall survival (OS; hazard ratio [HR] 0.546; P = 0.035) with 80.9% of patients alive at 3 years versus 64.2% in the low-BMI group. BMI was also an independent prognostic factor for OS in multivariate analysis (HR 0.557; P = 0.043). CONCLUSION We could show a significant association between overweight/obesity and improved OS in an unselected DLBCL cohort.
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Affiliation(s)
- L Weiss
- Department of Internal Medicine III, Paracelsus Medical University, Salzburg
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Hourdequin K, Schpero W, McKenna D, Piazik B, Larson R. Toxic effect of chemotherapy dosing using actual body weight in obese versus normal-weight patients: a systematic review and meta-analysis. Ann Oncol 2013; 24:2952-62. [DOI: 10.1093/annonc/mdt294] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Han X, Stevens J, Bradshaw PT. Body mass index, weight change, and survival in non-Hodgkin lymphoma patients in Connecticut women. Nutr Cancer 2013; 65:43-50. [PMID: 23368912 DOI: 10.1080/01635581.2013.741760] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Evidence is emerging that obesiy and weight gain may affect the prognosis of several types of cancer. We investigated the impact of body mass index (BMI) as well as pre-and postdiagnosis weight changes on non-Hodgkin lymphoma (NHL) prognosis. A cohort of 573 female incident NHL cases diagnosed during 1996-2000 in Connecticut was followed for a median of 7.8 yr. Self-reported height and weight at 3 time points before and after diagnosis were collected. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using proportional hazard models adjusting for factors believed to be associated with overall survival of NHL. Underweight (BMI < 18.5; HR = 2.84; 95% CI = 1.12-7.15) before diagnosis was associated with poorer survival compared to being normal weight (18.5 ≤ BMI < 25). Prediagnosis weight loss (HR = 1.42; 95% CI = 1.02-1.97) and posttreatment weight loss (HR = 1.98; 95% CI = 1.14-3.45) and weight gain (HR = 1.85; 95% CI = 1.04-3.32) were associated with poorer survival. NHL patients who were underweight, lost weight prediagnosis, or change weight after treatment were found to have a poorer survival.
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Affiliation(s)
- Xuesong Han
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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33
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Vecchio L, Seke Etet PF, Kipanyula MJ, Krampera M, Nwabo Kamdje AH. Importance of epigenetic changes in cancer etiology, pathogenesis, clinical profiling, and treatment: what can be learned from hematologic malignancies? Biochim Biophys Acta Rev Cancer 2013; 1836:90-104. [PMID: 23603458 DOI: 10.1016/j.bbcan.2013.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 01/25/2013] [Accepted: 04/10/2013] [Indexed: 02/06/2023]
Abstract
Epigenetic alterations represent a key cancer hallmark, even in hematologic malignancies (HMs) or blood cancers, whose clinical features display a high inter-individual variability. Evidence accumulated in recent years indicates that inactivating DNA hypermethylation preferentially targets the subset of polycomb group (PcG) genes that are regulators of developmental processes. Conversely, activating DNA hypomethylation targets oncogenic signaling pathway genes, but outcomes of both events lead in the overexpression of oncogenic signaling pathways that contribute to the stem-like state of cancer cells. On the basis of recent evidence from population-based, clinical and experimental studies, we hypothesize that factors associated with risk for developing a HM, such as metabolic syndrome and chronic inflammation, trigger epigenetic mechanisms to increase the transcriptional expression of oncogenes and activate oncogenic signaling pathways. Among others, signaling pathways associated with such risk factors include pro-inflammatory nuclear factor κB (NF-κB), and mitogenic, growth, and survival Janus kinase (JAK) intracellular non-receptor tyrosine kinase-triggered pathways, which include signaling pathways such as transducer and activator of transcription (STAT), Ras GTPases/mitogen-activated protein kinases (MAPKs)/extracellular signal-related kinases (ERKs), phosphatidylinositol 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR), and β-catenin pathways. Recent findings on epigenetic mechanisms at work in HMs and their importance in the etiology and pathogenesis of these diseases are herein summarized and discussed. Furthermore, the role of epigenetic processes in the determination of biological identity, the consequences for interindividual variability in disease clinical profile, and the potential of epigenetic drugs in HMs are also considered.
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Affiliation(s)
- Lorella Vecchio
- Laboratory of Cytometry, Institute of Molecular Genetics, CNR, University of Pavia, 27100 Pavia, Italy
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Carson KR, Bartlett NL, McDonald JR, Luo S, Zeringue A, Liu J, Fu Q, Chang SH, Colditz GA. Increased body mass index is associated with improved survival in United States veterans with diffuse large B-cell lymphoma. J Clin Oncol 2012; 30:3217-22. [PMID: 22649138 DOI: 10.1200/jco.2011.39.2100] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Obesity increases the risk of death from many malignancies, including non-Hodgkin's lymphoma (NHL). In diffuse large B-cell lymphoma (DLBCL), the most common form of NHL, the association between body mass index (BMI) at diagnosis and survival is unclear. PATIENTS AND METHODS We evaluated the association between BMI at diagnosis and overall survival in a retrospective cohort of 2,534 United States veterans diagnosed with DLBCL between October 1, 1998 and December 31, 2008. Cox modeling was used to control for patient- and disease-related prognostic variables. RESULTS Mean age at diagnosis was 68 years (range, 20 to 100 years); 64% of patients were overweight (BMI, 25 to < 30) or obese (BMI, ≥ 30). Obese patients were significantly younger, had significantly fewer B symptoms, and trended toward lower-stage disease, compared with other BMI groups. Cox analysis showed reduced mortality in overweight and obese patients (overweight: hazard ratio [HR], 0.73; 95% CI, 0.65 to 0.83; obese: HR, 0.68; 95% CI, 0.58 to 0.80), compared with normal-weight patients (BMI, 18.5 to < 25). Treatment during the rituximab era reduced the risk of death without affecting the association between BMI and survival. Disease-related weight loss occurred in 29% of patients with weight data 1 year before diagnosis. Cox analysis based on BMI 1 year before diagnosis continued to demonstrate reduced risk of death in overweight and obese patients. CONCLUSION Being overweight or obese at the time of DLBCL diagnosis is associated with improved overall survival. Understanding the mechanisms responsible for this association will require further study.
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Affiliation(s)
- Kenneth R Carson
- St Louis Veterans Affairs Medical Center, Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8056, St Louis, MO 63110, USA.
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Callera F, Brasil AAV, Casali ARDL, Mulin CC, Rosa ES, Barbosa MDA, Vieira TDF. Oncohematological diseases in the Vale do Paraíba, State of São Paulo: demographic aspects, prevalences and incidences. Rev Bras Hematol Hemoter 2011; 33:120-5. [PMID: 23284259 PMCID: PMC3520636 DOI: 10.5581/1516-8484.20110032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 02/20/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Based on the necessity of detailed information that supports effective strategies to improve cancer outcomes in the different regions of Brazil, the aims of this study were to report demographic aspects and to calculate the prevalence and incidence rates of oncohematological diseases in the region of Vale do Paraíba. METHODS This is a multicentric prospective study carried out from October 2009 to March 2010. A total of 500 over 19-year-old patients were enrolled. Data such as type of healthcare insurance, gender, age, ethnic classification, place of residence, schooling, income, body mass index, new cases and the period between the first symptoms and a definite diagnosis were collected. The prevalence and incidence rates were calculated according to an estimated number of 1,319,800 inhabitants. RESULTS The prevalence and incidence rates per 100,000 inhabitants in the period of six months were, respectively: acute myeloid leukemia 1.5 and 0.7; acute lymphoblastic leukemia 0.5 and 0.1; chronic lymphocytic leukemia 2.4 and 0.4; chronic myeloid leukemia 6.2 and 0.8; Hodgkin's lymphoma 2.9 and 0.9; non-Hodgkin lymphoma 9.8 and 4.3; multiple myeloma 5.7 and 0.7; myelodysplastic syndromes 2.1 and 0.2 and myeloproliferative syndromes 5.1 and 0.3. CONCLUSION Giving the paucity of data in this field of investigation, our data may be useful for comparisons with those of other regions of Brazil and will assist in the implementation of treatment programs of oncohematological diseases in this region.
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Affiliation(s)
- Fernando Callera
- Grupo de Onco-hematologia do Vale do Paraíba - GOHV, São
José dos Campos, SP, Brazil
| | | | | | - Carla Cecília Mulin
- Grupo de Onco-hematologia do Vale do Paraíba - GOHV, São
José dos Campos, SP, Brazil
| | - Evandro Secchi Rosa
- Grupo de Onco-hematologia do Vale do Paraíba - GOHV, São
José dos Campos, SP, Brazil
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Navarro WH, Loberiza FR. Obesity and lymphoma therapy: not a bad combination after all. Leuk Lymphoma 2010; 51:1590-1. [PMID: 20807091 DOI: 10.3109/10428194.2010.512096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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